39 patients with tibial shaft fracture had treated by open reduction and internal fixation with AO DCP and screws applying on the medial surface of the tibia, at the Department of Orthopedic Surgery, Ulsan Dongkang Hospital, from January, 1983 to December, 1985. A clinical study was done on all the 39 cases with the follow-up check over 1 year. In general, because the lateral surface of the tibia is well covered by rich soft tissue, it is popularized to apply the plate on the lateral aspect of the tibia. In our department, we applied the plate on the medial aspect of the tibia, which resulted in mimi-zing soft tissue injuries and, by inserting the screws perpendicular to the surface of the bone, increased stability of the fixation; and therefore resulted in relatively short operation time, relatively low incidences of infection and non-union; but there had been some drawbacks such as focal skin necrosis, hematoma, adhesion after fixatives removal, and cosmetic disfiguring. But there were no problems during the follow up periods. So, this is a recommandable procedure of internal fixation with the plate for the tibial shaft fractures.
Clinical Study ; Fixatives ; Follow-Up Studies ; Hematoma ; Humans ; Incidence ; Necrosis ; Orthopedics ; Skin ; Soft Tissue Injuries ; Tibia ; Ulsan

The traditional treatment for the femoral shaft fractures in children is closed reduction by continuous traction, usually for 2–3 weeks, until the fracture has achieved partial stability, followed by spica cast immobilization. Fifty three cases, from 3 to 10 years of age, has been treated with closed reduction and immediate application of hip spica csst; all of them were closed fractures of femoral shaft and were not associated with head, abdominal, or vascular injuries. Any angulations in excess of acceptable ranges were corrected with wedging the cast; any overridings in excess of acceptable ranges were corrected by skeletal traction for 1 week, followed by incorporation of the pin to the cast. The resultant overriding and angulation of fragments were within acceptable ranges, and complications were not significant.This method of treatment not only is likely easy in nursing care and comfortsble to the patients but also has some advantages of short stay in the hospital, better utilization of hospital beds, and costsaving. This immediate hip spica cast immobilization seems to be a good method of treatment for the femoral shaft fracture in children.
Child ; Clinical Study ; Fractures, Closed ; Head ; Hip ; Humans ; Immobilization ; Methods ; Nursing Care ; Traction ; Vascular System Injuries

No abstract available.
Humans ; Intracranial Aneurysm* ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: This study was aimed at investigating the role of betaadrenoceptor subtypes in mediating the relaxation and contraction of seminal vesicles in rabbits. MATERIALS AND METHODS: Relaxation or contractile responses of epithelium- removed muscle strips of a rabbit seminal vesicle, which were precontracted with 10-5M norepinephrine, to selective betasubtypes-adrenoceptor agonists were observed in an organ bath. The contractile responses induced by isoproterenol were also observed after application of selective antagonists. RESULTS: Isoproterenol showed a concentration-dependent contractile response, but the contractility was weaker than those with phenylephrine and norepinephrine. The betaselective-agonists(xamoterol for beta, clenbuterol for beta and BRL37344 for beta) alone evoked neither contraction nor relaxation. However, the beta- and beta-agonists inhibited the contraction of the precontracted strips with 10-5M norepinephrine, while the beta-agonist enhanced the contraction. The pretreatment with a beta-antagonist(ICI118551) reduced the tension of the strips developed by 10-4M isoproterenol, but the beta-(atenolol) and beta-(SR59230A) antagonists showed no changes in the response. CONCLUSIONS: beta- and beta-adrenoceptors seem to mediate the relaxation of the seminal vesicle, while the beta-adrenoceptor may have a supplementary role in contraction.
Baths ; Clenbuterol ; Isoproterenol ; Negotiating ; Norepinephrine ; Phenylephrine ; Rabbits ; Relaxation* ; Seminal Vesicles*

A 39 year old man suffering from pheochromocytoma and coronay artery obstruction diseases was scheduled for coronary artery bypass graft surgery before an adrenalectomy. General anesthesia was induced with fentanyl and midazolam and maintained with intermittent administration of fentanyl and low concentraion of isoflurane. At 5 minutes after commencement of cardiopulmonary bypass (CPB), the mean arterial pressure suddenly elevated to 150 mmHg. Sodium nitroprusside and labetalol were administered rapidly, however, mean arterial pressure could not be lowered below 100 mmHg. After release of aortic cross clamp, the electrocardiography showed tachycardia (150 beats/min) with wide QRS and systolic arterial pressure elevated to 180 mmHg. Antiarrhythmic drugs, inotropic and antiischemic drugs were administered. Thereafter tachycardia was disappeared and systolic arterial pressure was lowered below 150 mmHg. We observed the paroxysmal hypertension and tachycardia during CPB that is considered to be attributed to the presence of pheochromocytoma. Therefore we suggest that continuous thoracic epidural anesthesia and pulsatile perfusion during CPB could be helpful in a patient with pheochromocytoma undergoing coronary artery bypass grafting.
Adrenalectomy ; Adult ; Anesthesia, Epidural ; Anesthesia, General ; Anti-Arrhythmia Agents ; Arterial Pressure ; Arteries ; Cardiopulmonary Bypass* ; Coronary Artery Bypass* ; Coronary Vessels* ; Electrocardiography ; Fentanyl ; Humans ; Hypertension* ; Isoflurane ; Labetalol ; Midazolam ; Nitroprusside ; Pheochromocytoma* ; Pulsatile Flow ; Tachycardia ; Transplants

The reverse doming of the anterior mitral leaflet by two-dimensional echocardiography was shown in 39 patients(83%) among 47 patients with aortic regurgitation. The reverse doming was noted in 21(80%) of 26 patients with mild AR and in 15(83%) of 18 patients with moderate AR and in all(100%) of 3 patients with severe AR. Thus observing the reverse doming of the anterior mitral leaflet by two-dimensional echocardiography may be an important auxiliary diagnostic aid in conjunction with well known other echocardiographic findings.
Aortic Valve Insufficiency* ; Echocardiography ; Humans

BACKGROUND: Pain on injection of rocuronium is a common clinical problem. We compared the efficacy of lidocaine, ketorolac, and the 2 in combination as pretreatment for the prevention of rocuronium-induced withdrawal movement. METHODS: For this prospective, randomized, placebo-controlled, double-blind study a total of 140 patients were randomly allocated to one of 4 treatment groups to receive intravenously placebo (saline), lidocaine (20 mg), ketorolac (10 mg), or both (n = 35 for each group), with venous occlusion. The tourniquet was released after 2 min and anesthesia was performed using 5 mg/kg thiopental sodium followed by 0.6 mg/kg rocuronium. The withdrawal response was graded on a 4-point scale in a double-blind manner. RESULTS: The overall incidence of withdrawal movements after rocuronium was 34.3% with lidocaine (P = 0.001), 40% with ketorolac (P = 0.004), and 8.6% with both (P < 0.001), compared with 74.3% with placebo. There was a significantly lower incidence of withdrawal movements in patients receiving the lidocaine/ketorolac combination than in those receiving lidocaine or ketorolac alone (P = 0.009 and 0.002, respectively). The incidence of moderate to severe withdrawal movements was 14.3% with lidocaine, 17.2% with ketorolac, and 2.9% with lidocaine/ketorolac combination, as compared to 45.7% with the placebo. There was no significant difference in withdrawal movement between the lidocaine group and the ketorolac group. CONCLUSIONS: Ketorolac pretreatment had an effect comparable to that of lidocaine in attenuating rocuronium-induced withdrawal movements and the lidocaine/ketorolac combination pretreatment, compared with lidocaine or ketorolac alone, effectively reduced withdrawal movements during rocuronium injection.
Androstanols ; Anesthesia ; Double-Blind Method ; Humans ; Incidence ; Ketorolac ; Lidocaine ; Prospective Studies ; Thiopental ; Tourniquets

BACKGROUND: The importance of the intrinsic analgesic properties of the alpha 2-agonist is difficult to establish, but many studies have shown the beneficial effect of epidural clonidine in postoperative pain management. The authors examined the analgesic effect of clonidine, a preferential alpha 2-adrenergic agonist, upon hemodynamics, and side effects during the post-operative period in patients undergoing Cesarean section. METHODS: Sixty healthy parturients undergoing Cesarean section with general anesthesia were divided into two groups as follows: 1) Epidural Morphine group: An initial dose of morphine 3 mg diluted with 10 ml of 0.125% bupivacaine was injected epidurally at time of the peritoneal closure, followed by a continuous epidural infusion of morphine 7 mg and 100 ml of normal saline for the postoperative 2 days. 2) Epidural Clonidine group: An initial dose of clonidine 150 microgram diluted with 10 ml of 0.125% bupivacaine was injected epidurally at time of the peritoneal closure, followed by a continuous epidural infusion of clonidine 1800 microgram and 100 ml of normal saline for the postoperative 2 days. Postoperative analgesia was assessed by recording the VAS (Visual Analogue Scale), PHS (Prince Henry Score) at postoperative 1, 2, 3, 6, 12, 24, and 48 hours. Blood pressure, heart rate, sedation, and side effects were also recorded. RESULTS: There were no statistically significant differences in the VAS and hemodynamic changes between the two groups, but the epidural clonidine reduced the PHS significantly at 1, 2, 3 postoperative hours (P < 0.05). There were less side effects in the cases of epidural clonidine as compared with epidural morphine. CONCLUSION: In comparison to epidural morphine, epidural clonidine produces a similar degree of analgesia but less side effects.
Analgesia ; Anesthesia, General ; Blood Pressure ; Bupivacaine ; Cesarean Section* ; Clonidine* ; Female ; Heart Rate ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Morphine ; Pain, Postoperative ; Pregnancy

PURPOSE: The exact role of angiogenesis in prostate cancer is unknown. We investigated whether endocrine therapy inhibits angiogenesis, and influences the expression of thrombospondin-1 (TSP-1), a potent inhibitor of angiogenesis, and vascular endothelial growth factor (VEGF) in prostate cancer. MATERIALS AND METHODS: Employing immunohistochemistry, we assessed the expression of VEGF and TSP-1 in archival tissues from 46 patients with metastatic prostate cancer (30 before androgen deprivation therapy and 16 after at least 6-months' duration of androgen deprivation therapy). For each tumour, microvascular density (MVD) counts were determined using immunohistochemical staining for factor VIII. The relationship between MVD and the expression of VEGF and TSP-1, the tumour grade was assessed in metastatic prostate cancer. RESULTS: The mean MVD counts (71.1 vessels per 200x high-power field) in 16 patients with metastatic cancer after androgen deprivation therapy was significantly higher than that (51.7) in 30 patients before androgen deprivation therapy (p<0.05). The immunohistochemical analysis demonstrated a higher TSP-1 expression (p<0.01), and a lower VEGF expression (p<0.01), in androgen deprivation group. There was no significant correlation between VEGF or TSP-1 expression and the mean MVD counts. The MVD counts had no correlation with Gleason scores or initial PSA levels. CONCLUSIONS: Endocrine therapy in metastatic prostate cancer significantly decreased MVD counts, the expression of VEGF and significantly increased the expression of TSP-1. The present study shows that decreased angiogenesis including changes in the expressions of angiogenic factors, might have an important role in the therapeutic effect of androgen deprivation in metastatic prostate cancer.
Angiogenesis Inducing Agents ; Factor VIII ; Humans ; Immunohistochemistry ; Prostate* ; Prostatic Neoplasms* ; Thrombospondin 1 ; Vascular Endothelial Growth Factor A*

PURPOSE: Basal cell adenoma of the salivary gland is an uncommon type of monomorphic adenoma. The most frequent location is parotid gland. It usually appears as a firm, mobile and slow-growing mass. Originally the term "basal cell adenoma" is described as a benign salivary gland tumor comprised of uniform appearing basaloid cells which are arranged in solid, trabecular, tubular, and membranous patterns. But the myxoid and chondroid mesenchymal like component as seen in pleomorphic adenoma is lacking in basal cell adenoma. We report a case of basal cell adenoma of parotid gland with review of the literatures. METHODS: The 59-year-old female patient was referred to our department with a painless palpable mass in the left preauricular region for about 1 year. Movable and nontender subcutaneous mass was palpable. There was no evidence of cervical metastasis in computed tomography and ultrasonography. On fine needle aspiration cytology, pleomorphic adenoma was suspected. Under general anesthesia, superficial parotidectomy including tumor was performed. The biopsy result was basal cell adenoma. RESULTS: Long-term follow-up for 54 months showed favorable result without evidence of recurrence except for temporary facial nerve weakness right after the surgery. CONCLUSION: Basal cell adenoma is the third most frequent benign tumor of the salivary gland, following pleomorphic adenoma and Warthin's tumor, although the incidence is low. The typical clinical feature of the basal cell adenoma is slowly growing, asymptomatic, and freely movable parotid mass. Basal cell adenoma should be also considered as a differential diagnosis of the parotid gland benign tumor.
Adenoma ; Adenoma, Pleomorphic ; Anesthesia, General ; Biopsy ; Biopsy, Fine-Needle ; Diagnosis, Differential ; Facial Nerve ; Female ; Follow-Up Studies ; Humans ; Incidence ; Middle Aged ; Neoplasm Metastasis ; Parotid Gland ; Parotid Neoplasms ; Recurrence ; Salivary Glands